Appropriateness of disposition following telemedicine consultations in rural emergency departments.
Appropriateness of disposition following telemedicine consultations in rural emergency departments.
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农村急诊部门远程医疗咨询后处置的适当性。
DOI：
10.1097/pcc.0000000000000337
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Marcin,JamesP
中科院分区：
文献类型：
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作者：
Yang,NikkiH;Dharmar,Madan;Kuppermann,Nathan;Romano,PatrickS;Nesbitt,ThomasS;Hojman,NaylaM;Marcin,JamesP
目的：比较一组接受儿科重症监护医生远程医疗咨询的急性病和受伤儿童与一组接受同一组医生电话咨询的类似儿童在八个农村急诊科住院的适当性。设计：2003年1月至2012年5月的回顾性队列研究。设置：北方加州的八个农村急诊科。患者：急性病和受伤儿童被分流到最高级别的分流类别，接受远程医疗或电话咨询。干预措施：远程医疗和电话咨询。测量和主要结果：我们通过使用第二代儿科入院风险评分和修订的儿科急诊评估工具计算入院风险，比较了远程医疗和电话队列之间的总体和分层预期入院率。共审查了138份图表; 74名儿童接受了远程医疗咨询，64名儿童接受了电话咨询。远程医疗队列的住院率低于电话队列（59.5% vs 87.5%; p< 0.05）。虽然远程医疗队列的预期入院率低于电话队列，但这些差异无统计学差异（儿科入院风险II，2.36 vs 2.58;修订的儿科急诊评估工具，2.34 vs 2.57）。当队列被分层为低水平时，（低于中位数）和高（高于中位数）入院风险队列，使用儿科入院风险II（低风险，18.25 vs 22.81;高风险，1.40 vs 1.54）或修订的儿科急诊评估工具结论：虽然接受远程医疗咨询的患者的总体入院率低于接受电话咨询的患者，但使用儿科入院风险II和修订的儿科急诊评估工具的预期入院率之间无统计学显著差异。我们的研究结果在以前的研究中可能是令人放心的，这表明远程医疗专业咨询可以帮助提供更合适，更安全和更高质量的护理。
Objectives:To compare the appropriateness of hospital admission in eight rural emergency departments among a cohort of acutely ill and injured children who receive telemedicine consultations from pediatric critical care physicians to a cohort of similar children who receive telephone consultations from the same group of physicians.Design:Retrospective cohort study between January 2003 and May 2012.Setting:Eight rural emergency departments in Northern California.Patients:Acutely ill and injured children triaged to the highest-level triage category who received either telemedicine or telephone consultations.Interventions:Telemedicine and telephone consultations.Measurements and Main Results:We compared the overall and stratified observed-to-expected hospital admission ratios between telemedicine and telephone cohorts by calculating the risk of admission using the second generation of Pediatric Risk of Admission score and the Revised Pediatric Emergency Assessment Tool. A total of 138 charts were reviewed; 74 children received telemedicine consultations and 64 received telephone consultations. The telemedicine cohort had fewer hospital admissions compared with the telephone cohort (59.5% vs 87.5%; p< 0.05). Although the telemedicine cohort had lower observed-to-expected admission ratios than the telephone cohort, these differences were not statistically different (Pediatric Risk of Admission II, 2.36 vs 2.58; Revised Pediatric Emergency Assessment Tool, 2.34 vs 2.57). This result did not change when the cohorts were stratified into low (below median) and high (above median) risk of admission cohorts, using either Pediatric Risk of Admission II (low risk, 18.25 vs 22.81; high risk, 1.40 vs 1.54) or Revised Pediatric Emergency Assessment Tool (low risk, 5.35 vs 5.94; high risk, 1.51 vs 1.81).Conclusions:Although the overall admission rate among patients receiving telemedicine consultations was lower than that among patients receiving telephone consultations, there were no statistically significant differences between the observed-to-expected admission ratios using Pediatric Risk of Admission II and Revised Pediatric Emergency Assessment Tool. Our findings may be reassuring in the context of previous research, suggesting that telemedicine specialty consultations can aid in the delivery of more appropriate, safer, and higher quality of care.